Dissociative Identity Disorder (DID): Signs, Symptoms, Causes, Diagnosis and Treatment
Dissociative Identity Disorder (DID) is a psychological condition characterized by the presence of two or more distinct personality states or identities within a single individual. According to Dr. Paul F. Dell, 2006, titled “Dissociation and the Dissociative Disorders,” and published in the Journal of Trauma & Dissociation, DID is commonly associated with severe childhood trauma.
The signs of dissociative identity disorder include identity shifts, memory lapses, and mood instability. A study by Dr. Elizabeth Howell in 2011, titled “Understanding Dissociative Identity Disorder,” and published by the American Journal of Psychiatry, emphasizes that patients often experience confusion about their identity.
Dissociative identity disorder is primarily caused by early childhood trauma, such as sexual or physical abuse. An article by Dr. Frank W. Putnam, 1997, titled “Dissociation in Children,” published by The American Journal of Psychiatry, states that 85% of DID cases are linked to severe trauma during early childhood.
The diagnosis of dissociative identity disorder is conducted through structured interviews and the Dissociative Experiences Scale. Dr. Colin Ross, 2007, in “The Assessment of Dissociative Identity Disorder,” published by the Psychiatric Clinics of North America, reports that 40% of patients with DID are diagnosed through clinical assessments.
The treatment of dissociative identity disorder includes long-term psychotherapy and medications for co-occurring symptoms. According to Dr. Richard Kluft, 2013, “Treating Dissociative Identity Disorder,” by the Journal of Trauma & Dissociation, about 50% of patients show improvement with sustained therapy and medication management.
What Is Dissociative Identity Disorder?
Dissociative Identity Disorder (DID), previously known as multiple personality disorder or split personality disorder, is a severe mental health condition where a person develops two identities or more, each representing distinct personalities or even gender identities.
These identities take control of the person’s behavior and thoughts at different times, leading to periods of confusion and detachment from their core identity. Dissociation refers to a psychological state where a person feels a disconnect from their memories, emotions, or surroundings, often as a protective mechanism against trauma.
DID is considered rare but not unheard of. According to a study by Putnam, 1997, titled “Dissociation in Children,” published by The American Journal of Psychiatry, it affects about 1.5% of the general population worldwide. This condition is closely associated with severe and prolonged childhood trauma, typically before age six.
A primary feature of DID is memory transfer, where one personality does not have access to the memories of another, leading to significant gaps in memory. For instance, one identity does not remember important life events experienced by the other identity. This phenomenon is what makes DID distinct, as it demonstrates how fragmented the individual’s sense of self becomes, with the separate identities often acting independently of one another.
What Are The Types Of Dissociative Identity Disorder?
The types of dissociative identity disorder are possession dissociative identity disorder and non-possession dissociative identity disorder.
Possession-dissociative identity disorder involves the presence of one or more distinct identities that appear to control the individual’s behavior, often perceived as an external spirit or force. Non-possession DID is characterized by different identities taking control without any external manifestation of possession. Both forms involve the development of separate personalities due to trauma. According to Dell, 2006, in “Dissociation and Dissociative Disorders,” published by Journal of Trauma & Dissociation, DID affects approximately 1.1% of the population globally.
The main types of dissociative identity disorder include:
- Possession-Type DID: In this form of dissociative identity disorder, one of the alternate identities takes full control of the individual’s body and actions. The person often has no memory of what occurred during these episodes, and the identity acts as though it is a completely separate person. Dr. Paul Dell also states that this type of DID is marked by dramatic personality shifts, often resembling traditional “possession.”
- Non-Possession-Type DID: Here, the person does not fully lose control or awareness but feels a disconnect between their identities. They feel a shift in personality but maintain some level of consciousness during these changes. This form of DID often manifests through feelings of detachment and confusion without the extreme dominance seen in possession-type cases. Dr. Paul Dell also notes that this type can involve more subtle changes, leaving the person feeling emotionally fragmented rather than overtly controlled.
What Are The Signs And Symptoms Of Dissociative Identity Disorder?
The signs and symptoms of dissociative identity disorder are memory gaps, identity shifts, sudden mood changes, and dissociative amnesia.
Individuals with DID experience lapses in memory, where one personality is unaware of the actions of another. These identity shifts occur suddenly, leading to confusion and disconnection from reality. A study by Dr. Colin Ross, 2007, titled “The Assessment of Dissociative Identity Disorder,” and published by Psychiatric Clinics of North America, notes that up to 90% of DID patients report severe memory disturbances and identity fragmentation.
The signs of dissociative identity disorder include:
- Unusual behaviors: these behaviors are defined as sudden or unexpected changes in actions or mannerisms. They are often because different identities control behavior at different times. This reflects the switching between two identities.
- Switching food preferences: This is a change in diet or food choices and occurs because each identity has different likes or dislikes. It signals the presence of distinct personalities.
- Amnesia: Amnesia is memory gaps where significant periods are forgotten. They are common and occur when one identity is unaware of the actions of another.
- Identity confusion: This is a state where individuals are unsure of their true selves. It causes individuals suffering from DID to feel disconnected from their core personality.
The symptoms of dissociative identity disorder include:
- Anxiety: This is a persistent feeling of fear. It is often linked to identity shifts and confusion and causes emotional distress.
- Delusions: These are false beliefs or distorted perceptions. They occur when different identities emerge, leading to confusion about reality.
- Amnesia: Defined as the inability to recall important information about oneself. It is frequently associated with identity transitions during dissociative episodes.
Other mental health symptoms associated with DID include depression, self-harm behaviors, and paranoia, which often accompany the complexity of managing multiple identities.
What Are The Causes Of Dissociative Identity Disorder?
The causes of dissociative identity disorder are childhood trauma, sexual or physical abuse, terrorism, war, and severe medical procedures.
According to the DSM-5-TR, American Psychiatric Association, 2013, DID primarily develops in early childhood, typically before the age of 9. During this critical developmental period, repeated trauma or abuse will fragment the child’s identity, leading to the formation of separate personalities as a coping mechanism. A study by Putnam, 1997, titled “Dissociation in Children,” by The American Journal of Psychiatry, shows that 85% of DID cases stem from severe childhood abuse.
Traumatic experiences, such as ongoing abuse, affect a child’s ability to integrate their personality into a cohesive whole, leading to dissociation. Childhood abuse, especially sexual and physical, also significantly increases the likelihood of DID development. According to a study by Ross, 2007, titled “The Assessment of Dissociative Identity Disorder,” published in the Psychiatric Clinics of North America, reported that nearly 90% of patients with DID experienced childhood abuse.
Environmental factors such as terrorism, war, or prolonged medical procedures, especially if caregivers fail to provide comfort and stability, also trigger DID in children. These stressors overwhelm the developing brain, causing dissociative states as a form of psychological defense.
How Is Dissociative Identity Disorder Diagnosed?
To diagnose dissociative Identity Disorder (DID), a combination of physical exams are conducted, as well as neurological assessments, medical history, and gathering detailed information from close relatives or friends. The psychiatrist and psychologist use physical and neurological exams to help rule out other conditions that could explain the symptoms, such as ADHD or neurological disorders.
Gathering information from close individuals helps provide insight into the patient’s behavior and memory gaps. However, DID is rarely diagnosed in childhood because its symptoms are often mistaken for imaginative play or behavioral issues. According to Ross, 2007, article titled “The Assessment of Dissociative Identity Disorder,” by the Psychiatric Clinics of North America, DID is rarely diagnosed in childhood because symptoms often go unnoticed or are misattributed to behavioral issues.
The DSM-5 criteria for diagnosing DID include:
- The presence of two or more distinct personalities or identities.
- Gaps in memory for personal information, daily events, or trauma.
- Symptoms cause significant distress in everyday functioning.
- The disturbance is not a part of cultural or religious practices.
- Symptoms are not attributable to substance use or other medical conditions.
What Are The Treatments For Dissociative Identity Disorder?
The primary treatments for dissociative identity disorder are psychotherapy, medication, and intensive outpatient programs. Psychotherapy, often long-term, aims to integrate the different identities and improve functioning. Medications like antidepressants or anxiolytics manage co-occurring symptoms like anxiety or depression, but they don’t treat DID directly. Dr. Richard Kluft, 2013, article titled “Treating Dissociative Identity Disorder,” by the Journal of Trauma & Dissociation, found that approximately 50% of patients with DID benefit from psychotherapy combined with medication for symptom relief and stabilization.
Intensive Outpatient Program
Intensive Outpatient Programs (IOP) are structured treatment plans where individuals receive therapeutic services while maintaining daily activities. These programs include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and sometimes hypnotherapy, all aimed at addressing trauma and helping patients integrate different identities.
IOPs are particularly helpful for dissociative identity disorder (DID) by offering a supportive environment without the need for full hospitalization. A study by Kluft, 2013, titled “Treating Dissociative Identity Disorder,” published in the Journal of Trauma & Dissociation, reports that up to 60% of DID patients benefit from these structured programs, as they provide regular therapeutic interventions while allowing patients to live independently.
Psychotherapy
Psychotherapy is the primary treatment for dissociative identity disorder (DID) and focuses on integrating multiple identities into a cohesive self. It includes therapies like Cognitive Behavioral Therapy (CBT), which helps patients manage negative thought patterns, and Dialectical Behavioral Therapy (DBT), which teaches emotional regulation. Hypnotherapy is also used to access repressed memories.
These approaches are crucial in addressing trauma and dissociation. According to Dr. Richard Kluft, around 50% of DID patients show improvement with sustained psychotherapy.
Medication
Medication is used as a supplementary treatment for dissociative identity disorder (DID) to manage co-occurring symptoms like anxiety and depression. Common medications include antidepressants, anti-anxiety drugs, and tranquilizers. These medications help stabilize the mood, reduce anxiety, and manage emotional stress but do not directly treat DID. Dr. Richard Kluft also states that medication is effective for about 40-50% of DID patients in alleviating mood-related symptoms when used alongside psychotherapy.
What Does A Person With DID Feel Like?
A person with Dissociative Identity Disorder (DID) often feels confused and detached from their surroundings and experiences periods of confusion due to memory gaps or sudden identity shifts. This causes individuals to be frustrated and stressed as they struggle to reconcile the different identities that control their behavior. According to Dr. Colin Ross, 2007, study titled “The Assessment of Dissociative Identity Disorder,” published by the Psychiatric Clinics of North America, nearly 90% of DID patients report feeling lost or out of control, contributing to emotional distress and difficulties managing daily life.
Is Dissociative Identity Disorder Serious?
Yes, Dissociative Identity Disorder (DID) carries a significant risk of suicide, with many individuals experiencing overwhelming feelings of isolation, frustration, and emotional turmoil. The disorder’s complexity, including identity confusion and emotional distress, contributes to the heightened suicide risk. The Psychiatric Clinics of North America indicates that approximately 70% of people with DID have attempted suicide, making suicide prevention and mental health support critical in the management of DID.
Who Is Most Affected By Dissociative Identity Disorder?
Dissociative Identity Disorder (DID) primarily affects individuals who have experienced severe childhood trauma, particularly before the age of 9. Studies show that women are more likely to be diagnosed with DID than men, largely due to a higher reported incidence of childhood sexual abuse among women. According to Dell, 75% of DID diagnoses are in women. Men, though equally affected by trauma, are often underdiagnosed due to different presentations of symptoms, such as aggression or criminal behavior.
Can you have BPD and DID at the same time?
Yes, you can have both Borderline Personality Disorder (BPD) and Dissociative Identity Disorder (DID) at the same time. While BPD is characterized by unstable relationships, self-image, and emotions, DID involves fragmented identities and memory gaps. Studies from Dell, 2006, “Dissociation and Dissociative Disorders,” Journal of Trauma & Dissociations suggest that approximately 30-50% of individuals diagnosed with DID also meet the criteria for BPD. This overlap is often due to both conditions being linked to early trauma and emotional dysregulation.
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